During the winter months, a 65-year-old man presents with livedo reticularis and purple fingertips. Other symptoms include arthralgia and weakness. Renal impairment is present on laboratory testing. Which of the following is the most likely diagnosis?

The symptoms are typical of cryoglobulinemia. Cryoglobulins are antibodies that precipitate under cold conditions and are associated with several diseases. There are three main types of cryoglobulin syndromes based on the immunoglobulin composition of the precipitating antibody. Most cryoglobulinemic vasculitis is Type II or mixed and seen secondary to hepatitis C virus infection. Cold agglutinin disease would present with hemolytic anemia. The other syndromes would not generally be temperature sensitive.